Healthcare contributions and the integrated care board ask

A healthcare contribution planning request usually fails on one of two points: it asks for revenue funding dressed up as capital, or it cannot show that the development itself causes the capacity problem. Both are regulation 122 failures. Before you negotiate the figure, make the integrated care board prove its evidence base, because the tests in regulation 122 of the Community Infrastructure Levy Regulations 2010 are statutory and an obligation that fails them cannot lawfully be a reason for granting permission.

Integrated care boards replaced clinical commissioning groups on 1 July 2022 under the Health and Care Act 2022. They are not statutory consultees on planning applications, so their requests arrive through the local planning authority, often late and often as a figure with a formula attached.

Who makes the request and what it rests on

The request normally comes in one of three forms. A primary care request for a named surgery or group of surgeries. An acute request for a hospital trust. Or a composite figure covering primary, community and acute services across a wider area.

The first is the most defensible and the third is the weakest. A named surgery with a list size, a premises floor area and a costed scheme of works is a case an inspector can test. A pooled figure spread across a county with no identified project is not, because there is nothing to relate the obligation to.

Ask for four things in writing before you engage with the arithmetic:

1. The project the money will be spent on, identified by site or premises.
2. The current and committed capacity of the facility, with the source and date of the data.
3. The calculation from your development's population to the floorspace or capital cost sought.
4. Confirmation of what national capital funding has been applied for or allocated to the same project.

If any of the four is missing, say so in the written response rather than at committee. A request that cannot answer them is one the officer will struggle to recommend.

Capacity data and how the catchment is defined

Primary care capacity is normally expressed as list size against a floorspace benchmark, with a shortfall converted into additional square metres and then into a capital cost. Each step is contestable.

List sizes move. A practice list taken at a point two years before your decision may already have changed, and the board should be using the current figure. Practice boundaries are not administrative boundaries, so a site 400 metres outside a boundary generates no patients for that practice even if it is nearer the building than half the existing list. And the floorspace benchmark has to come from somewhere identifiable, which in practice means the Health Building Notes rather than a local rule of thumb.

The population calculation is where most schemes lose money unnecessarily. The board will multiply units by an average household size. Check which figure it has used and against what source, because the census average for the authority, the average for the ward, and the average for the dwelling mix actually proposed are three different numbers. A scheme of one and two-bedroom flats does not generate the household size of a district dominated by family housing, and census data published by the Office for National Statistics will support the point.

Applying the three obligation tests

Regulation 122 permits an obligation to be taken into account only where it is necessary to make the development acceptable in planning terms, directly related to the development, and fairly and reasonably related in scale and kind.

The necessity test is the one worth fighting. It requires the absence of the contribution to make the development unacceptable, not merely to leave a service under pressure. Where a service is already at capacity and the development adds a small proportion of demand, the board has to explain why the planning harm is attributable to the development rather than to an existing deficit.

Inspectors have reached different conclusions on healthcare requests, and appeal decisions are indicative of how the tests have been approached rather than binding precedent. Read the reasoning rather than the outcome.

Capital against revenue, and why that decides most requests

This is the distinction that resolves the majority of disputes. NHS treatment and the general medical services provided by a GP practice are funded through national allocations and national tariff arrangements that follow the patient. A contribution towards the cost of treating additional patients is therefore a contribution towards revenue, and it fails the necessity test because the funding already exists.

Capital is different. Extending a surgery, fitting out additional consulting rooms, reconfiguring a building to create clinical space, or acquiring premises are capital projects with identifiable costs that national revenue allocations do not cover.

So the question to put is narrow: what is the capital project, where is it, and what does it cost. Where the answer is a building, the request may well be lawful. Where the answer is a service, it probably is not. Keep that distinction in the written response and in any Viability Assessment, because an appraisal that carries an unlawful contribution as a cost weakens every other figure in it.

Double counting with national funding and with the levy

Two kinds of double counting arise. The first is where the same capital project has already attracted national funding, so the contribution duplicates money the project is getting anyway. Ask the question directly and get the answer in writing.

The second is where the authority charges the Community Infrastructure Levy and healthcare appears on its infrastructure list. The regulation 123 pooling restriction was removed in September 2019, and authorities must now publish an annual infrastructure funding statement showing what has been collected and what it has been spent on. That statement is the document to read before accepting that a contribution is additional to levy receipts rather than a second bite at the same infrastructure.

Where the authority has collected levy receipts and allocated none of them to healthcare over several years, the point is worth making. It goes to necessity rather than to fairness, because an authority holding unspent receipts for the infrastructure it says is deficient has a weaker case that the deficiency makes your development unacceptable.

Negotiating the sum

Three levers tend to move the figure. The household size input, the catchment definition, and the capital-only scope. Working through all three before discussing viability is better practice than leading with affordability, because a reduction obtained on necessity grounds is permanent and a reduction obtained on viability grounds invites a review mechanism.

Where viability does limit what the scheme can bear, the order of priority between obligations matters. Affordable housing is normally the authority's first call, and the approach in our note on independent review of a viability appraisal applies to a healthcare request in exactly the same way. Costs in the appraisal need the same discipline, as our piece on highway works costs in a development appraisal sets out.

A Health Impact Assessment is a different document and should not be confused with a response to a contribution request. It addresses the health effects of the development, and some authorities require one for major schemes as a validation item.

Clawback, monitoring and what the deed should say

Get three provisions into the deed. A defined spend period, commonly five or ten years from receipt, with repayment of any unspent balance together with interest. An obligation on the authority to provide evidence of expenditure on request. And an index, usually a published construction cost index, applied from a stated base date rather than from the date of the agreement.

Monitoring fees are permitted where they are proportionate to the obligations being monitored. A fee calculated as a flat percentage of the contribution, with no relationship to the monitoring actually required, is worth questioning.

And name the recipient properly. A deed that pays the contribution to the authority for onward transmission, with no obligation to pass it on within a stated period, is how healthcare money ends up in an infrastructure funding statement years later with no project attached.

Browse all 66 report types to see which documents a major application needs alongside the obligations work. This is general guidance, not legal advice. Check the position with your local planning authority or a qualified professional before relying on it.

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